Posts filed under ‘Infecciones virales’

Tickborne Diseases — Confronting a Growing Threat

N Engl J of Medic August 23, 2018

PERSPECTIVE

C.I. Paules and Others

Every spring, public health officials prepare for an upsurge in vectorborne diseases. As mosquito-borne illnesses have notoriously surged in the Americas, the U.S. incidence of tickborne infections has risen insidiously, triggering heightened attention from clinicians and researchers …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1807870?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1807870

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September 4, 2018 at 8:34 am

Ending Use of Oral Poliovirus Vaccine — A Difficult Move in the Polio Endgame

N Engl J of Medic August 30, 2018

PERSPECTIVE

M.A. Pallansch

When the world embarked on a mission of global polio eradication with the adoption of a World Health Assembly resolution in 1988, there was only minimal consideration of what would happen after the eradication of wild poliovirus (WPV) had been certified …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1808903?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1808903

September 4, 2018 at 8:33 am

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.813–816

IDSA GUIDELINE

J Michael Miller; Matthew J Binnicker; Sheldon Campbell; Karen C Carroll; Kimberle C Chapin …

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team.

This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions.

This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections.

Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times.

In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap.

The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.

FULL TEXT

https://academic.oup.com/cid/article/67/6/813/5088024

PDF (CLIC en PDF)

September 2, 2018 at 10:40 am

Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis

Clinical Infectious Diseases September 1, 2018 V.67 N.5 P.676–686

EDITOR’S CHOICE

Michael W Traeger; Sophia E Schroeder; Edwina J Wright; Margaret E Hellard; Vincent J Cornelisse..

This systematic review and meta-analysis of 17 open-label studies published to 2017 found that daily HIV pre-exposure prophylaxis use among men who have sex with men is associated with increased sexually transmitted infection diagnoses and an increase in condomless sex.

Background

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM.

Methods

We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed.

Results

Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19–2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99–1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users.

Conclusion

Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.

FULL TEXT

https://academic.oup.com/cid/article/67/5/676/4917600

PDF (CLIC en PDF)

September 2, 2018 at 10:36 am

Ending Use of Oral Poliovirus Vaccine — A Difficult Move in the Polio Endgame

N Engl J of Medicine August 30, 2018  V.379 P.801-803

Perspective

M.A. Pallansch

When the world embarked on a mission of global polio eradication with the adoption of a World Health Assembly resolution in 1988, there was only minimal consideration of what would happen after the eradication of wild poliovirus (WPV) had been certified.

Poliovirus eradication efforts have targeted three distinct serotypes, using two vaccines, each containing components against all three types — a live attenuated oral poliovirus vaccine (OPV) used in more than 100 mostly low- and middle-income countries worldwide and an inactivated poliovirus vaccine (IPV) used in most of the developed world…

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1808903?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1808903

 

N Engl J of Medicine August 30, 2018  V.379 P.834-845

Type 2 Poliovirus Detection after Global Withdrawal of Trivalent Oral Vaccine

I.M. Blake and Others

BACKGROUND

Mass campaigns with oral poliovirus vaccine (OPV) have brought the world close to the eradication of wild poliovirus. However, to complete eradication, OPV must itself be withdrawn to prevent outbreaks of vaccine-derived poliovirus (VDPV). Synchronized global withdrawal of OPV began with serotype 2 OPV (OPV2) in April 2016, which presented the first test of the feasibility of eradicating all polioviruses.

METHODS

We analyzed global surveillance data on the detection of serotype 2 Sabin vaccine (Sabin-2) poliovirus and serotype 2 vaccine–derived poliovirus (VDPV2, defined as vaccine strains that are at least 0.6% divergent from Sabin-2 poliovirus in the viral protein 1 genomic region) in stool samples from 495,035 children with acute flaccid paralysis in 118 countries and in 8528 sewage samples from four countries at high risk for transmission; the samples were collected from January 1, 2013, through July 11, 2018. We used Bayesian spatiotemporal smoothing and logistic regression to identify and map risk factors for persistent detection of Sabin-2 poliovirus and VDPV2.

RESULTS

The prevalence of Sabin-2 poliovirus in stool samples declined from 3.9% (95% confidence interval [CI], 3.5 to 4.3) at the time of OPV2 withdrawal to 0.2% (95% CI, 0.1 to 2.7) at 2 months after withdrawal, and the detection rate in sewage samples declined from 71.0% (95% CI, 61.0 to 80.0) to 13.0% (95% CI, 8.0 to 20.0) during the same period. However, 12 months after OPV2 withdrawal, Sabin-2 poliovirus continued to be detected in stool samples (<0.1%; 95% CI, <0.1 to 0.1) and sewage samples (8.0%; 95% CI, 5.0 to 13.0) because of the use of OPV2 in response to VDPV2 outbreaks. Nine outbreaks were reported after OPV2 withdrawal and were associated with low coverage of routine immunization (odds ratio, 1.64 [95% CI, 1.14 to 2.54] per 10% absolute decrease) and low levels of population immunity (odds ratio, 2.60 [95% CI, 1.35 to 5.59] per 10% absolute decrease) within affected countries.

CONCLUSIONS

High population immunity has facilitated the decline in the prevalence of Sabin-2 poliovirus after OPV2 withdrawal and restricted the circulation of VDPV2 to areas known to be at high risk for transmission. The prevention of VDPV2 outbreaks in these known areas before the accumulation of substantial cohorts of children susceptible to type 2 poliovirus remains a high priority. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa1716677?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1716677

August 30, 2018 at 8:41 am

Viral meningitis in the UK: time to speed up

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.930-931

COMMENT

Matthijs C BrouwerDiederik van de Beek

The differential diagnosis in patients with suspected CNS infection ranges from life-threatening disease (bacterial meningitis or herpes encephalitis) to typically less concerning disease (viral meningitis), or benign or no disease.1,  2 In the diagnostic work-up of these patients, clinical characteristics fail to differentiate between CNS infections and other diagnoses, and cerebrospinal fluid (CSF) analysis is the main contributor to the final diagnosis.3 In view of the urgent nature of this testing in patients with suspected bacterial meningitis, physicians are advised to carry out lumbar puncture without delay…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30287-1/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930287-1

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LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.992-1003

ARTICLE

Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

Fiona McGill, PhDMichael J Griffiths, DPhilLaura J Bonnett, PhDProf Anna Maria Geretti, PhDBenedict D Michael, PhDNicholas J Beeching, FRCPDavid McKee, FRCPPaula Scarlett, DCRIan J Hart, PhD …

Background

Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.

Methods

We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.

Findings

1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.

Interpretation

Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.

Funding

Meningitis Research Foundation and UK National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30245-7/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930245-7

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August 25, 2018 at 11:13 am

Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink.

Br J Dermatol. December 2016 V.175 N.6 P.1183-1194.

doi: 10.1111/bjd.14815.

Matthews A1, Turkson M1, Forbes H1, Langan SM1, Smeeth L1, Bhaskaran K1.

Abstract

BACKGROUND:

Statins are commonly prescribed worldwide and recent evidence suggests that they may increase the risk of herpes zoster (HZ).

OBJECTIVES:

To quantify the effect of statin exposure on the risk of HZ in the U.K.

METHODS:

A matched case-control study was conducted using data from U.K. primary care and hospital records. Patients > 18 years with an incident diagnosis of HZ were matched to up to four controls for age, sex and general practice. Patients were included in the statin exposure group if they had ever used a statin, and the daily dosage of the most recent statin prescription and the time since the most recent statin prescription were also recorded. The primary outcome was an incident diagnosis of HZ. Odds ratios (ORs) were estimated from conditional logistic regression and adjusted for potential confounders.

RESULTS:

A total of 144 959 incident cases of HZ were matched to 549 336 controls. Adjusted analysis suggested strong evidence for an increase in the risk of HZ related to statin exposure (OR 1·13, 95% confidence interval 1·11-1·15). There was also an increased risk when dosages were increased for patients who were currently or had recently been receiving statin treatment (Ptrend < 0·001), and we found an attenuation of the increased risk of HZ in previous statin users as the time since last statin exposure increased (Ptrend < 0·001).

CONCLUSIONS:

These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of HZ.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215701/pdf/BJD-175-1183.pdf

August 24, 2018 at 4:09 pm

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